Provider Demographics
NPI:1629536719
Name:HJERT, CORALL SKIE
Entity Type:Individual
Prefix:
First Name:CORALL
Middle Name:SKIE
Last Name:HJERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12702 WAGNER RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-9775
Mailing Address - Country:US
Mailing Address - Phone:425-319-7512
Mailing Address - Fax:
Practice Address - Street 1:300 W HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99251-2515
Practice Address - Country:US
Practice Address - Phone:425-777-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer